Impact of disability on quality of life in rural Bangladesh 297

J HEALTH POPUL NUTR 2002 Dec;20(4):297-305 2002 ICDDR,B: Centre for Health and Population Research
ISSN 1606-0997 $ 5.00+0.20
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addressed to: Dr. G.M. Monawar Hosain
3911 Loch Glen Court
Houston, TX 77059
USA
Email: ghosain@sph.uth.tmc.edu
Impact of Disability on Quality of Life of Rural
Disabled People in Bangladesh
G.M. Monawar Hosain
1
, David Atkinson
2
, and Peter Underwood
3
1
Community Health Research and Training Unit, University of Western Australia,
324 Striling Highway, Claremont, WA 6010,
2
Aboriginal Medical and Dental Health Unit,
University of Western Australia, Nedlands, Perth, WA 6009, and
3
Department of
General Practice, University of Western Australia, 324 Striling Highway,
Claremont, WA 6010, Australia
ABSTRACT
This study examined the impact of disability on the quality of life of disabled people in rural
Bangladesh. A primary healthcare specialist conducted a door-to-door survey in two villages in
Bangladesh to collect socioeconomic and demographic information on the villagers and for
identification of disabled people. Information on disability and how it affected their life was also
obtained either from the disabled people or from their caregivers by interviewing them. The study
revealed that disability had a devastating effect on the quality of life of the disabled people with a
particularly negative effect on their marriage, educational attainment, employment, and emotional
state. Disability also jeopardized their personal, family and social life. More than half of the disabled
people were looked at negatively by society. Disabled women and girl children suffered more from
negative attitudes than their male counterparts, resulting in critical adverse effects on their psychological
and social health. A combination of educational, economic and intensive rehabilitative measures
should be implemented urgently to make them self-reliant. Collaborative communication between
professionals and parents, behavioural counselling, formation of a self-help group, and comprehensive
support to families will reduce their suffering.
Key words: Disability; Quality of life; Inequalities; Impact studies; Bangladesh
INTRODUCTION
The World Health Organization has defined health as a
complete physical, mental and social well-being and not
merely the absence of disease or infirmity. The concept
has more recently been extended to include health-
related quality of life (1,2). According to the international
classification of impairments, disabilities, and handicap,
impairment is concerned with physical aspects of health,
disability has to do with the loss of functional capacity
resulting from impaired organ, and handicap is a measure
of the social and cultural consequences of an impairment
or disability (1). Disability affects physical health, social
relationship of people, life in the realms of family,
friends, and neighbours, psychological state, and level
of independence (3). The consequences of disability can
have an impact at personal, interpersonal, family and
social levels.
Although disability is as old as the human race, the
issue of disability and the experiences of disabled people
have received little consideration in general academic
circle (4). These issues have been marginalized, and only
in the disciplines of medicine and psychology, has
disability been given an important place. People with
disabilities remain at the margins of society as one of
the impoverished groups (5). The International Year of
Disabled Persons in 1981 stimulated much interest
worldwide in disability. UNICEF has estimated that four-
fifths of the disabled people of the world live in
developing countries (1). The overall low levels of
298 J Health Popul Nutr Dec 2002 Hosain GMM et al.
development and inadequate health and social welfare
services have all contributed to the persistence of poor
quality of life among the disabled people in these
countries, particularly in Bangladesh. It is generally
agreed that more information on the extent of the impact
of disabilities is required to formulate future policies
aiming at improving the quality of life of disabled
people (6,7).
The quality of life of disabled people has been
studied in developed countries. As the various health
indicators of population are improving in developing
countries, attention should now shift to improve the
quality of life of the marginalized and under-privileged
groups. In Bangladesh, where life is difficult for many
able-bodied people, disabled people are more likely to
face much greater problems in the absence of a
disabled-friendly environment. They are less likely to
be educated, employed, or rehabilitated. Social
segregation of disabled persons is extremely
widespread (8). Moreover, social welfare services do
not still provide special privileges for the disabled. As
a result, most disabled people usually face insensitivity,
cruelty, and often pity. The dominance of a medical
model of disability has tended to blame the victim
which, as Imrie states, shows people with disabilities
as inferior, dependent and of little or no value (5).
This discrimination prevents or confuses thinking about
solutions. Although some changes in approach have
taken place, there is still a need for major changes if
disabled people are to be integrated comfortably within
mainstream society.
Attempts have been made to publish a series of
papers on disability in Bangladesh. One paper on the
prevalence and pattern of disability and another on the
use of healthcare by disabled people have already been
published (6,9). The present paper reports the results
on impact of disability. Disability affects the different
facets of life of a person, and this life is often
complicated by negative forces, such as ignorance,
prejudice, negativism, and insensitivity. The study
attempted to explore and understand disability,
particularly in the light of its psychological and social
impacts. The results of this study are expected to help
us understand in detail the impact of disability on the
quality of life of disabled people in rural Bangladesh.
This, in turn, will guide policy-makers in framing laws
and prioritization and allocation of resources to create
a disabled-friendly environment in Bangladesh.
MATERIALS AND METHODS
A house-to-house survey was conducted during 1991 in
two villages of Manirampur upazila (subdistrict) under
Jessore district of Bangladesh. Manirampur upazila is
served by a 31-bed government hospital with eight
qualified physicians. The two villages, Parala and
Bahirgharia, are situated about 5 km east of Manirampur
upazila headquarters and are similar in terms of various
sociodemographic aspects, such as housing, income,
education, etc., having a total population of 1,906 residing
in 376 households. Many of these households are extended
families. Most people in this area are Muslims, and their
main occupation is farming. Some non-government
organizations (NGOs) work in the field of microcredit in
this area. These two villages are, thus, representative of a
modernizing Bangladesh, with rural character, strong
family bonds, and limited access to modern amenities.
While results from these two villages may not be as readily
generalizable as results from a large-scale cluster sample,
data obtained from these two villages are much more likely
to be valid and accurately reflect what is actually
happening in the selected villages.
A qualified primary healthcare specialist conducted
the fieldwork over four months. Collection of quality data
on a sensitive issue, such as disability, requires time and
cultural sensitivity on the part of the researcher, and trust
on the part of respondents. To develop a good rapport with
the villagers, the researcher stayed in the study villages
during the whole data-collection period, i.e. from August
to November 1991. The study population included all
disabled people who were the usual residents of the
villages at the time of the study which was carried out in
three stages. First, a house-to-house survey was carried
out in the two villages using a structured questionnaire to
collect socioeconomic and demographic information from
the villagers and for identification of disabled people. In
the second stage, information on disability and how it
affected their life was collected either from each disabled
person or from his/her caregiver using an interview
schedule with both open- and close-ended questions.
Disabled people who were children or who had substantial
problems with communication were not interviewed
directly. The third stage involved the collection of in-depth
qualitative data through 10 informal focus-group
discussions and 12 personal interviews on a sub-sample
of both able-bodied and disabled people. In addition,
observations made in the villages were used for
supplementing this information. The respondents were
assured that information so collected would not be
disclosed to any other people.
Impact of disability on quality of life in rural Bangladesh 299
International classification of impairment, disability, and
handicap was used by the researcher to define disability
(1). The term disability was defined as any restriction
or lack (resulting from an impairment) of ability to
perform an activity in the manner or within the range
considered normal for a human being. Types of
disability were also classified according to their
classification into seeing difficulties, hearing
difficulties, movement difficulties, learning
difficulties (mental retardation), speech difficulties,
strange behaviour (mental disorder), fits, feeling
difficulties (sensory), and others, such as alcoholism,
drug dependency, severe malnutrition, severe dyspnoea,
advanced stage of cancer and tuberculosis, etc. (1). This
survey estimated the impact of disability through
measuring certain aspects of quality of life using the
standard instrument, SF-36 (Short Form-36). This
instrument is widely used throughout the world, and its
validity and reliability is widely established (10). We
used only nine items from that form and added some
other questions of our own.
Most questions relating to the impact of disability
were investigated using a series of open-ended questions
and were later regrouped. All the questions were not,
however, asked to all respondents due to their inherent
inappropriateness. Effect on schooling was asked only
to those disabled people who were aged 5-30 years. It
was not asked to older disabled people as there was no
primary school in that area 30 years ago. Effect on
employment was asked only to those disabled people
who were male and were aged over 12 years. In this
rural community, since women are not usually involved
with any regular or salaried jobs, questions relating to
employment were asked to men only. Questions relating
to effect on marriage and changes in family perception
were asked either to the disabled people or to the
caregivers of the younger disabled and to those who had
a severe communication problem. Our experience from
other studies indicate that, by 10 years of age, children
with disabilities learn that it is less desirable to be
disabled (11). Reasons for emotional problems, changes
in community activities, and changes in social attitudes
were asked only to those disabled people who were aged
over 10 years and those who did not have any severe
communication problem.
The association of independent variable gender with
different dependent variables was tested using chi-square
and odds ratios to measure its association. As most
variables were regrouped as categorical variables, we
analyzed data using chi-square, measuring the p values,
and Fishers exact test was also used for statistical
significance where a cell value was less than five. All
were set at p<0.05 for statistical significance. All
statistical analyses were performed using SAS software
(12).
RESULTS
As mentioned earlier, the prevalence and patterns of
disability found in this study have been described
elsewhere (6,9). In total, 162 disabled people were
identified in the study area. This study revealed that
disability could have devastating effects on the life of
disabled people. These effects may either be at the
personal level, at the family level, or at the social or
community level.
Education
Fifty-seven disabled persons were eligible to respond to
this question. The problem reported by or on behalf of
41 disabled people (71.9%) was related with school
attendanceeither being unable to attend school due to
disability (n=15), or being compelled to leave school
due to their disability (n=26).
Employment
Sixty-nine male disabled people were eligible to answer
this question. Fifty-five (79.7%) reported that disability
had some negative consequence on their employment.
Nineteen disabled people (27.5%) who were employed
could not earn as much as did people who were not
disabled. Eighteen disabled people (26.0%) were forced
to change their employment either voluntarily or because
they had lost their previous employment. Another 18
(26.0%) had been unemployed (either dismissed or had
not been able to work).
Marriage
This was considered for all the disabled people. One
hundred twenty-two disabled people (75.3%) responded
that disability had no obvious effect on the marital status
of any members of their family, while 40 (24.7%) stated
that disability had affected the marriage prospects of one
or more family member(s). Of these 40 disabled people,
19 (47.5%) were unable to marry, and 9 women were either
divorced or separated due to disability (Table 1). Seven
people reported that disability had been responsible for
the delayed marriage of one of the other members of their
family. The presence of a disabled female in a family
(37.2%) was 3.93 times more likely to be reported to have
300 J Health Popul Nutr Dec 2002 Hosain GMM et al.
had an effect on marriage in the family than the presence
of a disabled male (13.1%), and this difference was
statistically significant (p=0.0007,
2
=11.25, 95%
confidence interval (CI) of odds ratio (OR)=1.69-9.28).
problems, and 86 (53.1%) posed different types of
problems to their families. Thirty-five (40.7%) of the
86 disabled people were considered to exert a problem
for the family because of the extra care they needed.
Table 1. Impact of disability on marital status
Frequency
Effect on marriage Male (n=11) Female (n=29) Total (n=40)
No. % No. % No. %
Cannot marry 5 45.5 14 48.3 19 47.5
Delayed marriage 4 36.3 6 20.7 10 25.0
Effect on siblings 2 18.2 5 17.2 7 17.5
Divorced/separated 0 0 4 13.8 4 10.0

2
=11.25, 95% CI of OR=1.69-9.28, p=0.0007
Emotional problems
This was considered for 125 of the disabled people,
excluding 23 children aged <10 years and those exhibiting
strange behaviour (n=14). Of the 125 people, 103 (82.4%)
reported a variety of emotional problems (Table 2). The
males were 1.43 times more likely to have emotional
problems (84.8%) than the females (79.7%), but it was
not statistically significant (p=0.59,
2
=0.28, 95% CI of
OR=0.52-3.97). The main cause that 25 disabled people
(24.3%) mentioned for their emotional disturbance was
grief and guilt arising from their disability itself. Another
group of 17 (18.4%) reported that their inability to earn
was the main cause of emotional distress. In this group,
the males as expected outnumbered the females (male=14,
female=5). Inability to perform household chores was an
important concern among the females.
Table 2. Reasons given for emotional disturbance
Frequency
Reason for distress Male (n=56) Female (n=47) Total (n=103)
No. % No. % No. %
Guilt over disability 11 19.6 14 29.8 25 24.3
Afraid of complications 10 17.9 8 17.0 18 17.5
People do not interact 10 17.9 7 14.9 17 16.5
Cannot earn 14 25.0 3 6.4 17 16.5
Will never be an able-bodied person 8 14.3 7 14.9 15 14.6
Cannot perform household chores 1 1.8 5 10.6 6 5.8
Others 2 3.6 3 6.4 5 4.9

2
=0.28, 95% CI of OR=0.52-3.97, p=0.59
Family perceptions
Perception of the family was examined for all the
disabled people. Seventy-six disabled people (46.9%)
were not considered by their families to pose significant
Twenty-eight (32.6%) were considered to be mainly
economic burdens, and 23 (26.7%) were also viewed as
social liabilities or problems, causing either social
embarrassment or a sense of guilt or shame.
Community activities
The question on participation in community activities
was asked to 125 disabled persons. Sixty-two disabled
people (49.6%) were said to be normal participants in
most community activities, such as sports, shopping,
ceremonies, functions, and religious festivals. The
remaining 63 (50.4%) were said not to be participating
normally in community activities (male=30, female=33).
The females were 1.52 times more likely (55.9%) not to
participate in community activities than the males
(45.5%), but this difference was not statistically
significant (p=0.32,
2
=0.98, 95% CI of OR=0.71-3.29).
Social attitude
The same 125 disabled persons were asked about social
attitudes towards them. Forty-nine persons (39.2%) felt
that they were treated noticeably differently from non-
Impact of disability on quality of life in rural Bangladesh 301
disabled people (Table 3). Of the 49 people, 12 (24.4%)
reported that they felt embarrassed by unnecessary
sympathy shown to them, and 8 (16.3%) stated that they
were frequently addressed in derogatory terms, and 8
replied more strongly that society simply hated them.
The females (44.1%) were 1.47 times more likely to
suffer from negative attitudes than their male (34.8%)
counterparts, but this difference was not statistically
significant (p=0.38,
2
=0.76, 95% CI of OR=0.67-3.23).
children dropped out before completing the 5th grade
(14). In our study, we found that all children with
disabilities were attending the same regular classroom
with virtually no extra help or resources made available
either to them or to their teachers. It is encouraging that
some NGOs in Bangladesh have established some
integrated programmes through supplying resource
materials and teachers to ordinary schools (15). In this
way, special education can be taught to them in the same
Table 3. Changes in social attitude
Frequency
Experience Male (n=23) Female (n=26) Total (n=49)
No. % No. % No. %
Over-sympathetic 7 30.4 5 19.2 12 24.5
Treated as being unimportant 7 30.4 4 15.4 11 22.4
Avoided 4 17.4 6 23.1 10 20.4
Teased 3 13.1 5 19.2 8 16.3
Hated 2 8.7 6 23.1 8 16.3

2
=0.76, 95% CI of OR=0.67-3.23, p=0.38
DISCUSSION
This study analyzed the situation of social status of
disabled people of rural Bangladesh through four months
of close observations on the villagers. It was thought
that quantitative data along with some qualitative
observations would bring out important issues that need
to be identified to satisfy the research questions.
The findings of the study showed that the working
disabled people were earning much less, and some of
them were even dismissed from their jobs. This result
corroborates the findings of Keir who has shown that
disabled people are often targets of prejudice and
discriminatory practices in areas of employment (13).
Modern rehabilitative services with proper training and
appropriate remedial education are generally aimed at
bringing them back into the work force. The improved
economic productivity of a group of disabled people
might change peoples perceptions about disability in
general. Special employment programmes in the form
of cottage industries could be implemented through local
government or by NGOs to rehabilitate them.
Our study has shown that disability has markedly
reduced the possibility of education. Of the 69 eligible
disabled persons, 18 (26.0%) attended school of any sort,
and of those who attended, 62% dropped out of their
classes. Among the dropouts there were
disproportionately more girls. This result is worse when
compared with another study where more than half of
site with non-disabled students without any special
school in the remote areas.
Disability had considerable devastating effect on the
marriage prospects of disabled people. The situation was
worse for females. In our study, females were more likely
to suffer from problems, such as cannot marry and
breakdown of marriage than their male counterparts.
We also observed that, in some cases, a huge dowry was
paid to some bridegrooms. A study by Palgi has shown
that spouses of eastern origin were more rejected by their
husbands after a disability than spouses of western origin
(16). Females in Bangladesh generally have a lower
status and are not as actively involved in income-
generating activities as males, and neither do they control
family resources. Thus, disability, apart from being
negative, is also a potential barrier to marriage, especially
for women.
Disabled people gave a wide range of reasons for
their emotional disturbance arising from disability.
Emotional problems, such as grief, depression, suicidal
tendency, and economic dependency, were related either
to disability itself or to their own or other peoples
reaction to disability. These people needed psychosocial
rehabilitation which is a relatively new approach for
assisting people with disabilities, particularly when there
is an emotional problem to adjust to living (17). People
with disabilities have individual physical, emotional,
social and intellectual needs and different personal bases
302 J Health Popul Nutr Dec 2002 Hosain GMM et al.
of knowledge, skills, experiences, and attitudes that all
together form a unique set of preconditions. Service
providers should be asked to enhance clients
expectations to help them view themselves as capable
of progress and to support the process of growth (18).
Thus, people need a psychosocial rehabilitation model
that upholds social supremacy rather than a medical one
in which treatments are limited to the provision of
medication to reduce symptoms.
As in other studies on disability conducted in
developing countries (19,20), a large number of disabled
persons in our study felt that their family considered them
as a burden or that there had been a change in the way
they were treated by their family. Our study also revealed
that the poorer families expressed a more negative
attitude towards disabled people. The more
understandable and seductive impetus behind this trend
is that of the financial pressure occasioned by the
growing burden of disability. The full provision of such
care by government funds appears to be impossible for
a poor country. But then what is to be done? The answer
lies in our traditional family values. Family care is widely
believed to be superior, more kindly, and sensitive, and
is more compatible with the kinship and family integrity
that already exists in this part of the world. Along with
this existing congenial atmosphere, the government
should provide some financial support.
More than half of the disabled people in our study
stated that they were viewed negatively by society, and
only a few felt that they were viewed positively. As in
other studies, it was found that the outward appearance
(for example, cerebral palsy, loss of a limb, burn
deformity) of a disabled person has a significant effect
on this negative attitude (19,20). Negative attitudes
resulted from the commonly-held belief that some
disabilities, such as mental retardation, cerebral palsy,
etc., were the result of divine punishment, and they
blamed their fate. This fear and lack of understanding
about disease processes exposed them to social
segregation, leading to considerable emotional distress.
As a result, they lost interest and became more isolated.
These negative attitudes towards persons with disabilities
are a significant obstacle to their successful integration
in society.
Some of the above findings clearly indicate that
various impacts of disability were clearly equal in males
and females. The pain of disability is sex-blind, but this
does not mean that the issues were the same for males
and females. Neither does it mean that the rehabilitative
services were equitable to all. It has also been seen in
other studies that the economic rationalization on
healthcare spending is also not equal, although women
work more in rural areas of developing countries (21,22).
Sen has further clarified that it is not the time spent but
the value of womens time in the South Asian region
that is perceived to be of lesser value (23). It is the deeper
social and cultural values concerning females that
contribute to their greater seclusion and worse condition
with more deprivation in all aspects. One can state that
a disabled woman would probably be the least likely to
have a good quality of life.
An important issue relating to qualitative data was
to examine how people felt about disabled individuals.
It was observed that people in general believed that those
with disabilities had suffered a terrible tragedy and were
forever bitter about their misfortune. How accurate are
these perceptions? The study found that there was no
difference in terms of happiness, frustration, or
satisfaction between disabled and non-disabled persons
other than the ratings of difficulty of life. The degree of
difficulty did not increase their feeling of frustration with
life or lower their feeling of satisfaction or happiness.
They agreed that there were periods of loneliness and
depression before making adjustments. Some disabled
people reported that their families were generally
supportive initially, but with time the attitudes changed
to negligence. This finding was not different from that
of Yuker (24). Most disabled persons viewed their
disability simply as a fact of life and accepted themselves
as they are. It is only at the stage when poor health
becomes associated with death or fear of death that their
happiness becomes difficult or impossible. We also
observed that many disabled people were not only quite
happy, but even derived some happiness from their ability
to cope with their difficulty which can be seen in the
case report. During the four-month stay in the study area,
it was also observed that women were more sympathetic
and considerate to disabled persons than males. It was
also seen that people with learning disabilities (mental
retardation) and strange behaviour (mental disorders)
were the most common targets of prejudice and
discriminatory practices. This finding is in line with that
of Pal et al. in India (25). Many respondents reported
that adjusting to societal attitude was the most difficult.
It was also observed that non-disabled people avoided
contact with disabled people.
Impact of disability on quality of life in rural Bangladesh 303
Our findings showed that the plight of disabled people
could be best explained by the minority group model.
The minority group paradigm is based on a
sociopolitical definition of disability as a product of
interaction between the individual and the environment
(26). In the other functional limitations model, no
attention is devoted to the possibility that the external
influence of negative perceptions is the primary source
of the problems that people with disabilities encounter
(22). This disadvantaged minority group is facing one
of the highest rates of poverty, unemployment, welfare
dependency, and a pattern of segregation in education
and social activities that parallels the practice of
apartheid. This model suggests that exterior forces
impose severe restriction on various types of abilities
rather than to suppose personal defects or deficiencies.
These are the problems that must be addressed first to
enable disabled people to lead a satisfying life.
This study has some limitations. It was a cross-
sectional study, so it was difficult to ascertain what the
cause is and what the effect or the temporal relationship
is between the two events. However, reverse causality
could be excluded as those possible (outcome) impacts
can hardly produce disability itself. There was also
always a risk of potential confounders, such as age,
gender, and socioeconomic status, that could explain the
difference between the groups. Given these limitations,
this study provides preliminary data and generates
hypotheses that can be more formally tested by
quantitative methods at a later time.
As a means of enhancing the quality of life of
disabled people, we suggest that our emphasis should
be directed towards changing the attitude of society. One
solution would be to increase contact between disabled
and non-disabled people. There is evidence that contact
with disabled persons results in the development of more
positive attitudes (27,28). What is clearly known is that
good attitudes and experiences should begin at the
earliest possible age. If there is any difficulty in
acceptance, an articulate parent of a handicapped child
can express his/her feelings about possible ridicule and
misunderstanding to the parent and student groups in
school. This will gradually increase their (disabled
childrens) acceptance without being forced. Going on
trips together and sharing leisure activities, holidays,
birthday parties, and other special events are positive
efforts. This sort of direct exposure will help influence
the feeling about handicapped people. Parents of disabled
children should also form a self-help group to exchange
views among themselves. Actually, when exposure is
denied, it becomes more difficult to accept handicapped
people as part of the environment around us.
The Government of Bangladesh has signed the
Universal Declaration of Human Rights, but the country
cannot meet the needs of disabled citizens due to
economic constraints. Several NGOs in Bangladesh have
been working with disabled people to make their life
socially and economically more productive. Disabled
people should be made aware of their rights, privileges,
and existing laws. Involvement of mass media is very
important for a general disability awareness programme
for the entire nation. A small amount of disability benefit
CASE STUDY
Wahed was congenitally blind. It was very difficult
for his parents to accept that their only son was
disabled. He did not attend school nor did he receive
any special training. He said, My parents still believe
that my blindness was due to their faultnot fulfilling
the commitment of sacrificing two khasis (goats) in
the name of God at the local dargah (mausoleum)
that my parents committed after the death of their
first son. He added, My parents took me to various
types of local faith healers and only at age five I was
first taken to an ophthalmologist, but it was too late.
So, they decided to involve me in religious-related
activities. My parents thought it would be better to
engage me in a local mosque. I started praying five
times a day, and I soon became the moazzin (who
calls for prayer) of the mosque. I started spending
the whole daytime in the mosque. He continued, I
am happy at least in one sense that I am taking care
of Gods house (mosque). I think God will forgive
our sins as we have dissatisfied Him earlier. In this
way, I would like to pay the price. I will spend the
rest of my life serving God. His parents feel proud
of him for becoming a hujur (religious leader), and
they are happy that Wahed can now earn money for
survival, particularly through religious activities
(milad), pani pora (chanted water), and selling
amulets. Wahed is now living happily with his parents.
He recently got married and has a one-year-old son.
He further added, People who used to call me earlier
in derogatory term as Kana (blind) Wahed now call
me choto hujur (little priest). I really feel proud of
it.
304 J Health Popul Nutr Dec 2002 Hosain GMM et al.
allowance in the form of a financial incentive could be
offered to them by the state. In general, most services,
including health, education, social welfare, and
institutions within the country, have to be adapted to the
needs of people with disabilities, and laws should,
accordingly, be framed. The model of a community-
based rehabilitation programme can provide the impetus
for an attitudinal shift from the restorative tradition and
unite rehabilitation workers through a cohesive
framework. A special behavioural counselling
programme could be offered to parents through this
community-based rehabilitation programme. Like Nilesh
(29), we would also like to caution that all community-
based services must be community-driven or directed
with proper empowerment, and their work should be
devoted to spending time listening to their community
or clients or advocating their interests.
ACKNOWLEDGEMENTS
We wish to express our gratitude to the AusAID which
provided the financial support to complete this study.
We also like to thank all respondents, guardians, leaders,
and volunteers who cooperated at various stages of this
study.
REFERENCES
1. World Health Organization. International
classification of impairments, disabilities, and
handicap: a manual of classification relating to the
consequences of disease. Geneva: World Health
Organization, 1980:3-13.
2. World Health Organization. Study protocol for the
World Health Organization project to develop a
Quality of Life assessment instrument (WHOQOL).
Qual Life Res 1993;2:153-9.
3. Barbotte E, Guillemin F, Chau N. Prevalence of
impairments, disabilities, handicaps and quality of
life in the general population: a review of recent
literature. Bull World Health Organ 2001;79:
1047-55.
4. Oliver M. The politics of disablement. Hampshire:
Macmillan, 1980:23.
5. Imrie R. Rethinking the relationships between
disability, rehabilitation, and society. Disabil Rehabil
1997;19:263-71.
6. Hosain GMM. Disability problem in a rural area of
Bangladesh. Bangladesh Med Res Counc Bull
1995;21:24-31.
7. Durkin MS, Davidson LL, Desai P, Hasan ZM, Khan
N, Shrout PE et al. Validity of the ten questions
screen for childhood disability: results from
population-based studies in Bangladesh, Jamaica,
and Pakistan. Epidemiology 1994;5:283-9.
8. Brown RI. Quality of life and rehabilitation: an
introduction. In: Brown RI, editor. Quality of life
for handicapped people. New York: Croom Helm,
1988:2-5.
9. Hosain GMM, Chatterjee N. Health care utilization
by disabled people; a survey in rural Bangladesh.
Disabil Rehabil 1998;20:337-45.
10. Ware JE, Kosinsli M, Keller S. SF-36: physical and
mental health summary scale: a users guide. Boston:
Health Institute, 1990:1-7.
11. Weinberg N. Growing up physically disabled:
factors in the evaluation of disability. Rehabil Couns
Bull 1982;26:219-27.
12. SAS Institute Inc. Cary NC 27512-8000. SAS
Proprietary Software release 6.04, USA, 1987.
13. Haq MS. Policies and programs concerning
disabilities and people with disabilities in
Bangladesh. In: Proceedings of the Regional
Seminar on Childhood Disability, Dhaka, 2-4
December 1994. Dhaka: Public Health Association,
1994:8.
14. Halim MA. Social welfare legislation in Bangladesh.
Dhaka: Oihik, 1993:7-14.
15. Keir N. Staff expectations for disabled persons.
Rehabil Couns Bull 1970;14:85-94.
16. Palgi P. Attitudes towards the disabled among
immigrants from middle-eastern countries. Public
Health 1962;3:16-7.
17. International Association of Psychosocial
Rehabilitation Services. Organizations providing
psychosocial rehabilitation and related community
support services in the USA: a national directory.
Virginia: McLean, 1985:6-8.
18. Shapira Z, Cnaan RA, Cnaan A. Mentally retarded
workers reactions to their jobs. Am J Ment Defic
1985;90:160-6.
19. Altman B. Studies of attitudes toward the
handicapped. The need for a new direction. Soc
Problems 1981;28:21-7.
20. Antonak R. Psychometric analysis of the attitude
toward disabled persons scale. Rehabil Couns Bull
1980;24:168-76.
21. Subedi J. Modern health services and health care
behavior: a survey in Kathmandu, Nepal. J Health
Soc Behav 1989;30:412-20.
22. Tennant A. Models of disability: a critical
perspective. Disabil Rehabil 1997;19:478-9.
Impact of disability on quality of life in rural Bangladesh 305
23. Sen A. The impact of the value of womens time on
food and nutrition. In: Tinker I, editor. Persistent
inequalities: women and world development. New
York: Oxford University Press, 1990:34-5.
24. Yuker HE. Attitudes towards persons with
disabilities. New York: Springer, 1988:98-103.
25. Pal HR, Saxena S, Chandrashekhar K, Sudha SJ,
Murthy RS, Thara R et al. Issues related to disability
in India: a focus group study. Natl Med J India
2000;13:237-41.
26. Minaire P. Disease, illness and health: theoretical
models of the disablement process. Bull World
Health Organ 1992;70:373-9.
27. Mitchell KR, Hayes M, Gordon J, Wallis B. An
investigation of the attitudes of medical students to
physically disabled people. Med Educ 1984;18:
21-3.
28. Block JR. Recent research with attitudes towards
disabled persons scale. New York: INA Institute,
1998:15-23.
29. Chatterjee N. Every solution has a problem. Disabil
Rehabil 2001;23:30-5.